Medical Staff for Encampments

[mikeylikey]

The Medical Officer for my Wing's  Encampment/ RCLS, has stepped down.  Is it a requirement that the Medical Officer be a Senior Member or could it be a Cadet.  I have looked everywhere for guidance, and unless I just overlooked it, I have no clue.  I have been told that Cadets can not perform this function, and that Cadets can perform this function.  Is there another publication I am just not aware of?  Any help would be great.  Also, what is the basic level of education training the medical officer should have?  THANKS FOR YOUR HELP!!

[PA Guy]

As a start read CAPR 160-1.

[Capt.karl]

I have been a Cadet Medic for the last 3 encampments that I have been too. One year we had one SM as a Medical Officer and last year we had 4 SM Medical Officers. The SM Medical Officer position is mainly a Mentorship position for their cadet counterpart. However there is NO requirement for a SM Medical Officer, only a requirement for qualified personel. If you have a Cadet Medic who is a NREMT-B and a SM who is First Aid, CPR. Then the cadet could just be the Medic for the encampment. I have only seen this once in my CAP career and probably will never see it again. A medical officer of the encampment has more authority then the Encampment Commander since this is CAP. If the Medical Officer believes that for safety reasons he/she must suspend the encampment they CAN do that. Even if the Encampment CC disagrees, the Medical Officer can go right to Wing CC, Reg CC, Natl. CC and have them suspend the encampment, if they disagree then the next step would be for the Medical Officer to resign and have CAP get sued over a blister on a cadets toe!

[mikeylikey]

^  A year later........anyway, I used Army Physicians and the Post medical clinic and it's personell for all my CAP Encampment needs.  I would also like to get rid of the  cadet medics that seem to be at every activity.  They are not allowed to provide MEDS, or anything more than a band-aid.

[PA Guy]

A medical officer of the encampment has more authority then the Encampment Commander since this is CAP. If the Medical Officer believes that for safety reasons he/she must suspend the encampment they CAN do that. Even if the Encampment CC disagrees, the Medical Officer can go right to Wing CC, Reg CC, Natl. CC and have them suspend the encampment, if they disagree then the next step would be for the Medical Officer to resign and have CAP get sued over a blister on a cadets toe!

Do you happen to have a cite for that, CAPR or....?

[PA Guy]

^  A year later........anyway, I used Army Physicians and the Post medical clinic and it's personell for all my CAP Encampment needs.  I would also like to get rid of the  cadet medics that seem to be at every activity.  They are not allowed to provide MEDS, or anything more than a band-aid.

A great solution, if it is available, to a difficult prob.  My wing does not utilize cadet medics.

[RiverAux]

I really HATE that term when used in association with any CAP activity as it just gives everybody the wrong impression and especially with cadets.  Start calling a cadet a "medic" and I'm really worried they're going to be attempting to perform a field tracheotomy on me that they saw on a MASH re-run if I stub mytoe.  It goes straight to their heads. 

[mikeylikey]

I really HATE that term when used in association with any CAP activity as it just gives everybody the wrong impression and especially with cadets.  Start calling a cadet a "medic" and I'm really worried they're going to be attempting to perform a field tracheotomy on me that they saw on a MASH re-run if I stub my toe.  It goes straight to their heads. 

Agreed.  I have had cadets in the past at special activities and Encampments break the rules, and try to cite medical reasoning for doing so.  One Cadet actually said he could stay int eh female Barracks overnight, because they had no medical person assigned to them.  So the next morning, I disbanded all Cadet Medics.....sent them to the DIFAC (Dining Facility) to wash posts and pans.  I can be a really ass sometimes, but when a CAP Cadet tries to tell his Commander (who Happened to also be an AD Army CPT) rules derived from military instructions and regulations........  Please, I am the REGULATION GURU.

[ZigZag911]

Agreed.  I have had cadets in the past at special activities and Encampments break the rules, and try to cite medical reasoning for doing so.  One Cadet actually said he could stay int eh female Barracks overnight, because they had no medical person assigned to them. 

That actually has a refreshing ring of originality about it!

However, I gather the cadet was not simply kidding verbally....it's a shame we don't allow keelhauling, although i guess then we'd need to get some keels!

Seriously, the only time I've ever seen cadet health services assistants (or EMTs....we NEVER called them 'medics'!) was in circumstances in which we had well-trained, reasonably mature cadet EMTs and an SM medical officer to supervise them.

Essentially they did what the MO told them (i.e., escorting a sick cadet to medical tent, helping someone apply an Ace bandage, and so forth)

[John Bryan]

Ok.....first please remember CAP Medical Officers, Nurse Officers and Health Services Officers are very limited in what we can do in the first place. What any health care professional (adult officer or cadet) can do while on CAP's time is a much larger issue.....we can maybe address that later.

As for the question of cadets serving in health services. CAP has a major problem in that most adult officers think that the word cadet = child.....that is not always the case. This also could be another debate.

We have cadets who are health care professionals. I have known cadets who have been Emergency Medical Techs, 1st Responders, Certified Nurses Aides, and Pharmacy Techs.....these are young adults who are all state licensed or certified in different health care professions and based on some state laws might be in greater positions of authority then most adult officers would think.

If for example a cadet ground team member is an EMT and the adult officer on the team is only 1st aid trained , then under Indiana (and many other states) law the cadet would be in charge of the scene and the victims and if the adult officer tried to block or override the EMT(Cadet) then the adult officer could be arrested. It is late so I have not looked up the IC (Indiana Code) number but it is on line.

Another thing.....although I have never met one....it would be possible for a cadet to be a nurse.....here's how. You finish High School at 17 , 1 year later your an LPN or 2 years later an RN and still under 21.

So whats my point.....only that a cadet who happens to be a health care professional is an asset to CAP just like an adult officer.

[mikeylikey]

^ No doubt, My gripe is with those cadets who have no healthcare experiance and work as an "Encampment Medic", carrying around band-aids, and a notebook. 

[flyguy06]

Ok.....first please remember CAP Medical Officers, Nurse Officers and Health Services Officers are very limited in what we can do in the first place. What any health care professional (adult officer or cadet) can do while on CAP's time is a much larger issue.....we can maybe address that later.

As for the question of cadets serving in health services. CAP has a major problem in that most adult officers think that the word cadet = child.....that is not always the case. This also could be another debate.

We have cadets who are health care professionals. I have known cadets who have been Emergency Medical Techs, 1st Responders, Certified Nurses Aides, and Pharmacy Techs.....these are young adults who are all state licensed or certified in different health care professions and based on some state laws might be in greater positions of authority then most adult officers would think.

But that is NOT the norm. And you are right, when people here the word "cadet", they think of teenagers. And I am sure parents who pay and send their children in our care for a week wouldnt be too comfortable knowing that their childs health is being monitored by a teeneager. You have to look at liabilities.

First off when I think of a medical officer, I think of a Doctor or a Nurse. i do not think of an EMT, Paramedic, or LPN.

They can do limited things and I guess wouldnt be a bad asset. But I would want someone of adult age and experience to be working on teenegaers that arent my own.

[Ned]

A brief review is in order:

We had a pretty good discussion about the role of Health Services Officers in CAP here.

Another good resource is CAPR 160-1.

Basically, no one in CAP is authorized to perform "routine medical care" at encampments for things like sprained knees, tummyaches, colds or fevers.

As in NO ONE.  Not CAP doctors, nurses, EMTs, CNAs, DCs, veternarians, or "medics".

I repeat -- it is a violation of our regulations for anyone -- including CAP medical folks -- to hold a "sick call" or treat anything other than a true life-or-limb threatening emergency at encampment or anywhere else.

And for good reason.  CAP, Inc. is not covered by any sort of medical malpractice insurance.  So any mistake (or even just a "bad outcome') by a CAP medical person performing routine care could literally mean the end of the corporation.

Our HSOs have an important role to play in educating our members, advising commanders on health-related policies, and screening applications and similar adminstrative support.  They are terrific folks who donate their professional skills to the CAP and deserve our respect and appreciation.

But they simply cannot put hands on a patient for anything other than a genuine emergency.

Really, really.


"Friends don't let friends endanger CAP by performing or allowing routine medical care to occur."

Ned Lee
Director of Cadet Programs, Pacific Region
Former CAP Legal Officer

[Major Lord]

Do I understand correctly then, that a cadet suffering from blisters ( at encampment) should either provide self-care with no senior member involvement, contact a parental-unit to arrange transportation to the family doctor, Doc-In-The-Box, or hospital, or just tough it out? Why then the emphasis on foot checks by Tac officers? Is there a regulatory exemption for blisters? It must be somewhere in the back of the reg book.....Perhaps we have expanded the threat of blisters to life threatening....

Major Lord

[Eclipse]

Thank you, Ned - I don't know why we have to keep saying this over and over, but if we do, we do.
I will say it as well, just so it keeps echoing:

THERE
IS
NO
SUCH
THING
AS
A
"CAP Medic"

(being an EMT, MD, RN, etc., who is also a member of CAP is >not< the same thing. Be prepared to quote the reg, pamphlet, and authorization before you take exception to this statement.)

As to the blister argument - I'd say it falls into the abyss of the gray area that is CAP health operations.

Common sense would say that treating a blister could fall within the basic first aid we are authorized to administer (if trained) within the team.

However, an argument could be easily made that we should not even do this - if an Encampment HSO
decides a blister is "minor", when in fact it winds up with an infection that costs a cadet his football career, or worse his foot, that cadet's parents could have an action against the HSO, since CAP would likely be held harmless because it could be shown the HSO acted against regs.

Common sense and goodwill mean little in a court of law with the right lawyer and the wrong jury.

Its also a vast chasm or regulations and risk between having someone who is an EMT or MD tracking meds and being the decider between "encampmentitis" and "dial 911", and staffing a full medical detachment with  a triage area and cadets running around with stethoscopes around their neck.
The former IMHO/IANAL would stand up much better within our regs and guideline than the latter.

This is a difficult situation for me to argue, because while I don't like or agree with the current situation, I have to do what I can, with reasonable judgment, to protect my members >and< the organization.

[Major Lord]

Ned's reply seemed emphatic enough to me:

"But they simply cannot put hands on a patient for anything other than a genuine emergency.

Really, really."

Given this emphatic and certainly legally correct interpretation, it seems to me that we have no room for "gray areas" or any reasonable belief that acting in good faith is any protection. Presumably, we should file IG grievances for the routine pre-or post- shower blister check.... We'll get right on that...right....

Is the blister check the CAP version of the "short-arm" inspection?

Major Lord

[mikeylikey]

I would also like to add that it is inappropriate for CAP members to interview cadets on what medical conditions they may have without a guardian present.  There are no psychologist, psychiatrist positions in CAP.  I have always hated when an activity sets time aside so that the "medical section" can do pre-admission interviews with cadets.

It is one thing to dump out cadets bags and search for illegal prescriptions, but to know a complete medical history and ask "are you depressed" is going way beyond the line.

I will back any parent who decides to sue the CAP because their child was precluded from activities because of "possible mental health disorders".  I had a huge problem with PAWG for the past 3 years for the very same reason.  (not me, I am some-what sane!)  If you get a chance check out PAWGS encampment and CLS websites.  The medical sections are the driving force behind both activities.  Terrible shame! 

[Eclipse]

I agree here, too. (With Lord).

If you've read "I, Robot", you'd understand why this is the kind of situation that would short out
a positronic brain - two opposing viewpoints which are equally correct.

Do you do what you know is the "Right thing to do", or the "right thing to do"?

[PHall]

Do I understand correctly then, that a cadet suffering from blisters ( at encampment) should either provide self-care with no senior member involvement, contact a parental-unit to arrange transportation to the family doctor, Doc-In-The-Box, or hospital, or just tough it out? Why then the emphasis on foot checks by Tac officers? Is there a regulatory exemption for blisters? It must be somewhere in the back of the reg book.....Perhaps we have expanded the threat of blisters to life threatening....

Major Lord

Paraphrasing for Ned:

Alan, Tac Officers are acting in loco parentus, i.e. subtitute parents while the cadet is at encampment.
And as such can do stuff like look at a cadet's feet and give them a band aid or some moleskin.
And that's about all we do. Anything worse and it's Doc-in-a-box time.

[Eclipse]

Do I understand correctly then, that a cadet suffering from blisters ( at encampment) should either provide self-care with no senior member involvement, contact a parental-unit to arrange transportation to the family doctor, Doc-In-The-Box, or hospital, or just tough it out? Why then the emphasis on foot checks by Tac officers? Is there a regulatory exemption for blisters? It must be somewhere in the back of the reg book.....Perhaps we have expanded the threat of blisters to life threatening....

Major Lord

Paraphrasing for Ned:

Alan, Tac Officers are acting in loco parentus, i.e. subtitute parents while the cadet is at encampment.
And as such can do stuff like look at a cadet's feet and give them a band aid or some moleskin.
And that's about all we do. Anything worse and it's Doc-in-a-box time.

It's "In loco parentis": http://en.wikipedia.org/wiki/In_loco_parentis
("loco parent us" is how most people with children feel"  )


And >maybe<, we say that they are, in fact all senior members are, certainly encampment staff, but I don't know if that trumps the legal issues of medical care, though I'm right with you on the attitude.

Its a legal mess, which is why most members do what they think is right and cross their fingers.

Its also why I continue to be stymied by activities which allow situations which are obviously way over the line.

[PHall]

Hey, never claimed to be a Latin expert. But you got the idea, so I count that as a success.

[Major Lord]

Phil,

I agree that we stand in loco parentis. Ned is a legal big dog, so I would not challenge him on this  ( although there have been several cases in which lawyers were demonstrated to be wrong)

Having Loco Parentis status means that we have the rights and obligations of the little badgers' parents. Now we create a regulation that says "we, as stand-in parents, have decided not to provide routine medical care within the scope of practice of any parent, for fear of being sued, after assuming responsibility for your children". The harm to the child is foreseeable, since we have agreed not to meet a standard of care which is inferred by our standing.

Further, we ask the parents to provide a medical waiver (form 31) and Hx questionnaire that implies that we will interpret and act upon any special health problems the cadet may have. We know in advance that no such service will be provided, and in fact may also be proscribed by regulations.

As an organization, we have either denied we stand in loco parentis, or we imposed a limitation on a doctrine of the common law by  CAP regulation. Both of these are legal assertions of questionable validity.

I don't see how the regulations provide any exemptions for blister treatment. I suppose you could argue that an assessment is not a treatment, but to say that either case is not "routine medical care" is specious.

Major Lord

[PHall]

I don't see how the regulations provide any exemptions for blister treatment. I suppose you could argue that an assessment is not a treatment, but to say that either case is not "routine medical care" is specious.

Major Lord

What blister treatment? Cadet shows us their feet after they have showered and answer a few questions. (How are the feet? Do you have any blisters? etc...)

If they have a blister or just an red area we give them a band aid or some moleskin and send them on their way.
And I mean just that, we give them the band aid and/or moleskin, they apply it themselves.
Homie don't touch no nasty feet!

Like I said before, anything that can't be handled by a band aid or some moleskin gets shipped off to the Doc-in-a box.

[Major Lord]

Phil,

So you knowingly and willfully provide a medical assessment of the cadet, and provide direction and materials for treatment? This sounds like "routine medical care" to me. ( The black IG van is pulling up in front of your house now...)

Believe me, I am not arguing that we should not care for our injured cadets (officially, I take no position on this, but as an EMT, you might guess my feelings)

What I am arguing is that the regulations are so over-broad, as to prohibit routine and common sense parental-standard practices. If the letter of the law was followed, encampments would not be possible. When we determine that for instance, a Cadet's chest pain is caused by running for a mile, rather than say, pneumonaultramicroscopicsiliovolcaniosis, are we not making a medical evaluation that any parent, or reasonable person, might make?

The regulations have been drafted in such a manner as to replace common sense and moral and legal duties. Its not the practice of Moleskinning that is wrong, its the regulations that prohibit it. I don't think that there is any question that CAP reg's flatly prohibit any routine medical aid, including cold packs, hot packs, or providing any over-the-counter medical aids, to include chapstick, Tylenol, sunscreen, ace bandages, bandaids, moleskin, vaporub, etc. You can argue that it is common sense and common practice  to do these things, but the practice is by CAP standards, illicit.

We need to make it clear to parents that when it comes to the health of their children, we assume no responsibility.( at least by choice)

Eventually, CAP will be sued by a parent or member, when we breech our duty of care to our "yoots" and National will revisit drafting such over-broad and ill advised regulations. If we have any money left to run the organization, at least all of us medical people can have "I told you so" rights. Small consolation.

Major Lord

[RiverAux]

What about providing water to prevent dehydration?  Requiring cadets to wear jackets to prevent hypothermia?  Could this be medical advice or treatment in the hands of some lawyers? 

Anyway, I agree with Maj Lord and others that our medical regulations are very messed up and CAP has seemingly done everything it can to confuse people.

[John Bryan]

It's about MONEY.....and the risk of lossing  it.

CAP Medical / HS personnel who want to take care of people should join the USCG Aux and be protected by the federal government. CAP is a private corp and needs to be careful.

I also think we should follow the regs to the letter. Send cadets to the hospital for blisters and every other little thing. The cost will maybe make CAP and the AF reconsider how we do business.

Don't collect meds at encampments...let the cadets keep them. When the ADD meds go missing and a cadet OD's then we will get sued and maybe the regs will be reviewed. Show me one summer camp in America that lets 12 and 13 yrs keep their meds in the cabin.

CAP is at risk for being sued no matter how you look at it.....but CAP members need to follow the rules and let the chips fall.

[Ned]

What about providing water to prevent dehydration?  Requiring cadets to wear jackets to prevent hypothermia?  Could this be medical advice or treatment in the hands of some lawyers? 

Guys,

Quit trying to think too hard.

You will hurt yourselves.   



Lawyers are not the enemy here.  No one has ever been sued for giving water to a CAP cadet or handing them a jacket when it is cold outside.

Because nobody outside a law school bull session or a internet bulletin board would ever remotely think that those things are "medical care," routine or otherwise.

While I agree that we could make the 160-1 a little clearer and provide some affirmative guidance to CP leaders, it isn't really all that mysterious.

Lay folks (as in people who don't hold a medical license of some sort) can do lay-people stuff without fear of lawsuits.  Hence TACs can pass out band-aids, sunscreen, and ask questions like "why are you limping, cadet?"

Mostly because Moms and Dads are not "practicing medicine without a license" when they care for their children in similar ways.

But lay people -- including Moms and Dads -- can't do stuff that requires a medical license; like surgery and diagnosing serious illnesses.

And by regulation in CAP, medical folks can't do routine care for the reasons we have discussed.

But TACs and other adult officers who who care for cadets can certainly use common sense and experience to pass out the moleskin and bandaids.

Remember, food is the number one cure for "hunger," a serious condition that can be fatal without intervention.

But thank Goodness you don't have to be a physician to run the dining hall.



Peace and common sense to all.


(BTW, a NHQ HSO committee is nearing the final stages of a revision to 160-1 that will address the medication and other issues.  The state laws vary tremendously across this great country, and it is very difficult to craft a policy that will be acceptable in all 50 states and various commonwealths and districts where CAP has overnight cadet activities.  But the good news is that we have a very good track record in caring for our cadets.)

[John Bryan]

Ned is correct Lawyers (well some lawyers) are not the enemy.  We have a great legal team at NHQ.....If I recall correctly the National Legal Officer's practice outside CAP is to defend doctors and medical people who are being sued. So the knowledge is there.

The problem is not the lawyer but the law and CAP regs. As long as we are Civil Air Patrol, INC and not the US Air Force Auxiliary we will have a lot of these problems. We have a lot of health care people who want to help hurting people from plane crash victims to cadets with blisters and a lot in between. The problem is they have there hands tied by our regs which are based in law suit prevention. If our status changed our medical folks could do what the USCG Aux medical folks do and that is act as USCG medical. The USCG Aux who are doctors, nurses, and other HSOs can actual work in USCG clinics treating active duty USCG members , retired members, and families. Those state laws and all are covered because they are a federal resource. What that means for example is a nurse who works for the VA in Ohio may have an Indiana license and there is no problem because she/he is a federal nurse who only needs to be licensed in one state.

So how do we change things....well we don't. The CAP and AF leadership would have to go to Congress. When will that happen? When the money (costs) lead them there. For example if we send 50 cadets to the hospital during a summber encampment for routine care and their HMO, PPO, whatever covers everything but $200....now NHQ pays $10,000....times say 40 wing encampments = $400,000.00.....my advice if you want change follow the regs. Right now we have doctors and nurses and medics (sorry) who are doing things like basic care and passing meds and such and CAP gets the best of both worlds, on one hand they are not spending the money on outside hospital care and they can cut loose the HSO if they are ever sued. Why do you think NHQ has never enforced these rules.....why do you think every encampment and other large event collects meds and then passes them. It's nuts......FOLLOW THE REGS. Let the cadets and adult officers go to ER for everything.....let the cadets keep their meds (including strong ones for ADHD). If all 52 wings followed the regs...the cost would lead to change.

[RiverAux]

Well, the CG Aux program may be dying out according to some statements I've heard.  I'm not sure that it really ever got much off the ground in the first place. 

[Ned]

John,

While I think we can all agree that CAP members should have access to quality medical care while attending CAP activities, I believe your "take everyone to the ER" advice is very ill-advised.

First, such activities do not apply any effective pressure to decision makers in CAP, the USAF, or Congress.  CAP, Inc is not liable for the medical costs of members, period.  If my kid goes to a civilian hospital during encampment, I am on the hook for any expenses not covered by my insurance, not CAP.

Second -- and more importantly -- sending anyone to an ER for routine care is wrong, and dangerous.  It is wrong because ERs are for . . . wait for it . . . emergencies.  It is dangerous because ERs are not equipped for routine care and any time they spend looking after non-emergent cases simply leaves less time and resources for true emergencies. 

I also think you may have made some unwarranted assumptions: many, if not most, encampments no longer routinely collect and store medications.  And while there are some scary exceptions, most CAP HSOs (especially the docs and nurses) understand and follow the regulations and do not perform routine care or prescribe medications.

National and regional headquarters (including folks like me) do in fact routinely enforce the regulations everytime we become aware of a problem.  I visit several encampments every year, and I do not see any widespread violations.

(But I hear about some in other regions.)

I agree with you that the only practical solution is some sort of legislative change through Congress, that would somehow give Federal status to our HSOs providing routine care to members and the general public.  This leads to the follow-on problem of educational and licensure standards.  Do we really want to make all of our HSOs meet USAF training and educational standards?  Maybe.

The only alternative is to purchase medical malpractice insurance that covers all of our HSOs as well as CAP, inc.  As we pointed out in the other thread, a conservative estimate would be several hundred thousand dollars a year to cover us in all 52 wings.  Money which, needless to say, we don't have.

It is also worth remembering that we are not exactly in crisis here.  CAP has hundreds of overnight activities every year, including 40 or so encampments.  For routine care, members have full access to the regular health care system:  their private physicians, clinics, and other providers.  In emergencies, CAP does pretty much what everyone else does -- we call 9-1-1 and the members will receive some of the best care in the world.

Would it be more convenient if CAP HSOs could offer routine care?  Absolutely.  I have commanded several encampments with more than 200 folks, and I would dearly loved to have had a doctor or PA to triage the tummy aches, "sprained" knees, and common colds.  I didn't have a CAP doc, so we made do with USAF medics, a non-member "camp nurse," and the local urgent care clinic.  The world did not come to an end, and nobody's health was endangered.

But I again strongly caution against a "send them all to the ER' policy.  It is not required by any regulation, it would not accomplish what you want it to, and it is wasteful of scarce health care resources.


Peace.

Ned lee

[RiverAux]

Several hundred thousand dollars is not much of CAP's budget and the AF wouldn't even notice the cost.  If a reasonable case can be made that our current system is causing actual problems then I think something could be done. 

However, I don't think reasonable people are in charge of CAP at the AF level.  The decisions that have come down lately over what missions they'll allow AFAM status for and which ones they won't have been so inconsistent that trying to predict what they would do about something like this is a sort of crap shoot. 

[Ned]

Several hundred thousand dollars is not much of CAP's budget and the AF wouldn't even notice the cost.  If a reasonable case can be made that our current system is causing actual problems then I think something could be done. 

Sure, we could add $10 to the dues for every senior and probably cover it, but I suspect we might get some push-back from the membership.  Remember, this is the same crew that complains bitterly if we tell them they have to buy a $3.00 uniform item sometime in the next two years.   

But I think you are right that the USAF would take some convincing before they would undertake such a large responsibility.  I can't begin to imagine how they would take responsiblity for the training and certification of such a diverse group of health care providers located in all 50 states and Puerto Rico.  But the larger problem is that they would almost certainly take the position that "if it isn't broken. . .."  From their perspective, we are already managing to ensure our members get routine care, and our HSOs are already permitted to help in genuine emergencies.

[Psicorp]

Just out of curiosity, I understand the liability issue with providing basic medical care, but how can we (CAP) say no to providing care if a Paramedic or Nurse has their own liability insurance?

[Eclipse]

Just out of curiosity, I understand the liability issue with providing basic medical care, but how can we (CAP) say no to providing care if a Paramedic or Nurse has their own liability insurance?

Its easy, just say it.  If a member chooses to take an action against a CAP directive, they would be subject to disciplinary action within the organization and would be forfeiting liability protection.

The "Scylla and Charybdis" here is that many states have laws which require licensed medical, fire, and law enforcement personnel to act and/or administer treatment in emergencies.  That debate is another ad nauseum discussion here.

It has to be made clear to these members, and should be discussed BEFORE its an issue, that in those circumstances they effectively remove their insignia and become agents of whatever agency or profession requires they act, with no implied or actual protection by CAP, or FTCA.

[Ned]

Just out of curiosity, I understand the liability issue with providing basic medical care, but how can we (CAP) say no to providing care if a Paramedic or Nurse has their own liability insurance?

Jamie,

The problem is that while such insurance may well protect the individual, it does not cover CAP, Inc., who would most likely be seen as the "employer" here.

IOW, if it should happen that a CAP HSO were to treat a member, and malpractice occurred, the member would sue not only the individual that committed the error, but also CAP, Inc. on a number of theories, including failure to train and/or supervise the HSO adequately, failure to provide necessary equipment and supplies, and/or simply on an employer-employee relationship.

If that happens, the HSO's insurance may well cover the HSO, but will not cover CAP, Inc.  Any lawyer seeking compensation for her/his client will always go after the "deep pocket" which in this case would the corporation.

And it wouldn't take too many multi-million dollar recoveries to make CAP, Inc simply go away.

As a practical note, even in cases where CAP wins the lawsuit or settles for a nuisance amount, we would incur legal fees amounting to tens of thousands of dollars.

So that is why we have the rule that says CAP members do not provide care in anything other than a genuine life-or-limb threatening emergency.

We could of course purchase medical malpratice insurance to protect the corporation, but that would cost several hundred thousand dollars a year.  Now add to that the legal fees to deal with the lawsuits, and you get some idea of how expensive it would get.

Ned Lee
Former CAP Legal Officer

[Psicorp]

Fair enough, sir, thank you.

I'm going to be starting Nursing School here shortly (mid-life career change), and had been (okay, still am) hoping to help out at Encampment on the medical side in a couple of years.  Maybe things will change by then.  [laughter] [/laughter]

[Jolt]

I remember at COS when Capt Waddel, a paramedic, came in to treat one of my roommates for a cut or something to the knee.  It obviously wasn't life threatening.  It was just oozing a little bit.  The treatment consisted of washing it off and bandaging it cut.

Would that have been considered routine care, Col Lee?  I know none of my roommates had a problem with it.

[Eclipse]

I remember at COS when Capt Waddel, a paramedic, came in to treat one of my roommates for a cut or something to the knee.  It obviously wasn't life threatening.  It was just oozing a little bit.  The treatment consisted of washing it off and bandaging it cut.

Would that have been considered routine care, Col Lee?  I know none of my roommates had a problem with it.

Only an IG,  judge, or jury could say for sure.

Clearly dressing a superficial wound is within both a paramedic's training and the community-level first aid CAP requires, but then it gets gray from there.

As a commander, a parent, and an adult with common  sense, I have a petty good idea what can and cannot fall under the duties of an HSO, however we all know common sense has no specific standing in an American court of law, especially a civil one where the jury thinks the defendant has deep pockets.

Trying to narrow it down here is going to be like trying to wrestle a greasy pig - you can get a pretty good grip on it, and then when you're not looking it'll get away from you.

The only thing any of us can do is our best within our own personal risk tolerance and skill set.

And then cross your fingers.

[capchiro]

An interesting case for discussion.  At a recent weeklong encampment, a cadet approached the chaplain and stated he wanted to go home.  the Chaplain, told the cadet he would be okay and to hang tough.  The cadet said he was depressed and began to cry.  The Chaplain told the youth that this was a common problem he had seen before and that the cadet was just feeling down due caffeine withdrawal.  He gave the cadet a waiver so the cadet could have a Coke at lunch each day (since all sodas were off limits).  The cadet did so and completed the training.  A success??  Perhaps.  Now the problems.  Was this a medical condition?  Could it have been a medical condition.  Could the cadet have been suffering from depression and committed suicide?  Was the Chaplain qualified to "diagnosis" any kind of nutritional or drug withdrawal??  Would a HSO been qualified to do so??  I think the Chaplain was very creative and it would appear that he did a good thing, but if it had gone wrong, it would have been a very bad thing to say the least.  What do you all think of this situation.  It really happened..

[Ned]

Guys,

Again I caution all of us about thinking too hard.

It doesn't take a licensed physician and surgeon to wash and bandage a scraped knee.

Mom does that every day, and nobody is threatening to arrest her for practicing medicine without a license.

Now if it is obviously infected, we have clearly gone beyond the "soap, water, and band aid" stage and it should be seen by a professional.

I'm pretty sure that any reasonable adult would see the difference and act accordingly.

Sure, there is always going to be some grey when we try to figure out exactly where the line is (what if it's a only a little red? ; what if it is so painful the cadet can't walk without limping?, etc.), but that is why we hire only hire adults with a little common sense to supervise troops.



As for the chaplain "diagnosing" depression, we are back at the same question.  If the kid is a feeling a little anxious over her/his new surroundings or perhaps homesick because this is the first night Junior has spend away from home, any sensible senior (including chaplains  ) will listen to the troop for a bit, reassure them that these are normal feelings for someone in their situation, and send them back to duty.

Heck, maybe even give the cadet a cookie.

But if the kid comes in saying things like "i've been diagnosed with clinical depression by my shrink, and my meds aren't working in this environment.  I am withdrawn, tearful, and feel like hurting myself or others" well, then the Chaplain is out of her/depth and needs to refer the kid to a professional.

And if you're not sure, ask another responsible adult.

Really, we have had thousands of encampments that have graduated several hundred thousands cadets without getting vapor-locked over whether telling a cadet to put moleskin on a blister is medical treatment that must be performed in a ER.

Nobody in CAP has ever paid a nickel in damages for acting responsibly, respecting and caring for cadets as we would our own kids, or applying common sense and experience to CP situations.

That's all we need to do.

[Slim]

Ned,

As usual, your words are very wise, and your experience and knowledge are worth listening to.  As someone who will be commanding his first encampment starting in 262 days, this is one of the many thoughts in my mind.

Our encampment does maintain a medical section.  It is typically staffed by 3-4 senior members who are EMTs and Paramedics at a minimum (we occaisionally have had an RN or doctor thrown in).  We certainly don't allow cadets with stethoscopes and 40 pound truama bags (nothing against cadets, stethoscopes or trauma bags, but cadets should be doing other things during encampment).  These guys and gals don't do anything more than what a TAC (or any reasonable person) would do when it comes to treatment.  If you would be so kind as to look at some scenarios and offer up an honest opinion.

• TAC notices a blister that's an angry red color and still draining fluid.  Thinking infection, he takes the cadet to the medic.  The medic says "Yeah, could be.  Let me put some Neosporin and a fresh dressing on it.  Keep an eye on it and let me know if it doesn't get any better."
  
• Cadet strikes his head on a low roof overhang, causing a deep laceration/avulsion.  Medic slaps some 4x4s on it, loads the cadet in the van with a driver, and goes downtown for some stitches/staples.
• After eating dinner, a cadet starts complaining about her throat feeling fuzzy, and some shortness of breath, so her flight sergeant takes her to medical.  The medic on duty, recognizing an allergic reaction, has HQ make a 911 call for an ambulance (about a 20 minute response time).  Meanwhile, the cadet says her throat feels like it's starting to close up, and she's having a hard time breathing.  So, the medic asks for her drug allergies, and having no contraindications, gives her some of his personal Benadryl.  Ten minutes later, when the ambulance arrived, the cadet was breathing fine, and having no other difficulties.  She still went downtown in the ambulance for an evaluation. (Later, we found out the cadet had a seafood allergy.  While we had been served chicken, the group before us had fish and the dining hall staff neglected to change the serving utensils.)  I will stipulate that this may have been pushing it, but I also know how fast anaphylactic shock can set in and be fatal.  Once that throat closes, the only way to get an airway is by tracheotomy or crichoidotomy.
• Cadet rolls his ankle on the O course.  Medics come along splint it to prevent any further injury, maybe put an ice pack on it to reduce swelling, and take the cadet downtown for some new photos.

In my mind's eye, I don't see these as being anything less than what the average parent would do in these situations (well, ok, not really, but don't get me started on abuse of the EMS system).  I also don't see any of these as being beyond basic, common sense first aid, or in the one (admittedly rare) case, lifesaving treatment, both of which I interpret as kosher by the 160-1.  And, nothing that can't be done by any senior at encampment.  We just prefer to recruit and use licensed professionals because they have the ability to recognize what they're seeing, and more importantly, what they can't see.

Short of bubblewrap BDUs, or calling an ambulance for every little thing, how can I ensure the safety of the cadets entrusted to ME, while protecting the corporation (and myself) from liability, and taking care of all those minor scrapes, bumps, cuts and bruises inherent to any encampment?  Do the provisions of 160-1 become moot just because a paramedic is the one to put the band-aid on?

I'm not trying to pick a fight here or anything, this is just one of those areas that I'm thinking about as a commander.

[Eclipse]

You didn't ask me, but what the heck...

This has been my worst nightmare for about 6 years, now.

Everything you said was reasonable and fine up to the giving personal Benedryl - you lost me there when you moved into allowing the HSO to make a diagnosis and then dispense a medication.

IMHO, at the point someone makes a diagnosis, they lose their insignia and corporate backing and must fall back on their professional insurance and requirements.

I wouldn't give anything, ANYTHING that is remotely medication to a cadet without express permission of that cadet's parent or legal guardian.  If a senior wants to self-medicate out of my kit, well, that's their choice.  A minor isn't legally allowed to make that choice.

The worst, most painful part of this whole situation is our volunteer status - as has been pointed out, no one can cite a case where a CAP member was sued successfully for making a best effort and common sense, but I certainly don't want to be the first, either.

Nice choice - let someone possibly die or sustain permanent injury instead of risking your own familiy's financial health.

And when you ask NHQ for real, specific guidelines, they point at the regs as if that's an answer.
And those paramedic wanna bes with "advanced first aid" and a stethoscope don't make it any easier for us, because everyone, including NHQ, knows that if and when the regs are relaxed, there will be stretching and abuse of the system - there already is today - you hear all the time about cadets who are candidates for ICU who get two salt tabs, a glass of water and sent back to their racks (instead of going to the ER or home).

Let our people start doing "real" EMT work and you'll have the rambo types giving each other field sutures
and splinting breaks.

[Jolt]

You didn't ask me, but what the heck...

This has been my worst nightmare for about 6 years, now.

Everything you said was reasonable and fine up to the giving personal Benedryl - you lost me there when you moved into allowing the HSO to make a diagnoses and then dispense a medication.

IMHO, at the point someone makes a diagnoses, they lose their insignia and corporate backing and must fall back on their professional insurance and requirements.

I wouldn't give anything, ANYTHING that is remotely medication to a cadet without express permission of that cadet's parent or legal guardian.  If a senior wants to self-medicate out of my kit, well, that's their choice.  A minor isn't legally allowed to make that choice.

Wow... How is an airway compromise not a real emergency?  You really don't need to be a heathcare provider to realize that you can't live if you can't breathe.

How about a new rule that would apply to this situation: "Save lives first, ask questions later."

[Eclipse]

You didn't ask me, but what the heck...

This has been my worst nightmare for about 6 years, now.

Everything you said was reasonable and fine up to the giving personal Benedryl - you lost me there when you moved into allowing the HSO to make a diagnoses and then dispense a medication.

IMHO, at the point someone makes a diagnoses, they lose their insignia and corporate backing and must fall back on their professional insurance and requirements.

I wouldn't give anything, ANYTHING that is remotely medication to a cadet without express permission of that cadet's parent or legal guardian.  If a senior wants to self-medicate out of my kit, well, that's their choice.  A minor isn't legally allowed to make that choice.

Wow... How is an airway compromise not a real emergency?  You really don't need to be a heathcare provider to realize that you can't live if you can't breathe.

How about a new rule that would apply to this situation: "Save lives first, ask questions later."

Of course an airway restriction or blockage is an emergency. however the scenario has EMS on the way.

If the cadet lives, you get a Comm Comm or better, if she dies, you may lose everything.

Professionals are >paid<, protected, and authorized to perform these functions, possibly even duty-bound.
Volunteers are not (at least not as-such).

The problem with this whole conversation, which is going to the same place they all do is that the question really is:

"What >would< I do?'  or "What >should< I do?"

The ultimate answer is impossible without a lawyer, two corporate officers, and specific details of the exact scenario.

My answer on a military installation in an urban area with EMS 3 minutes away may not be the same as someone on a wilderness mission in the California mountains.

[Ned]

Chris,

See that's the thing.

It's an legitimate question:  "If a TAC can do it, why can't a medic do exactly the same thing?"

And the answer is because the TAC is acting as a lay-person, doing the TAC thing, but medical professionals can never act as lay people -- they are licensed professionals that are held to higher standard.

Think about it.  The whole point of a negligence/malpractice suit is that the doc failed to meet the "standard of care" of folks with her/his license.  While a lay person is simply held to the standard of an ordinary guy on the street.  If a doc could avoid liability by saying "hey, I wasn't acting as a doc when I sutured that wound, I was acting as a layperson and successful Home Ec grad," then there wouldn't be much left of the whole malpractice thing.

So the law holds medical professionals to the standard of medical professionals, even when doing stuff that a layperson could do.

To tie this back to your hypos, if a TAC could do it, then a TAC should do it.  If it sounds like the TAC couldn't handle it, so we bumped it up to the medical professionals, then that's probably what happened and the dreaded "routine medical care" probably occurred, even if all that happend was that the medic washed it and put on moleskin.

Part of being a medical professional is the skill in diagnosis that tells you when NOT to do something, so the fact that they chose not to do something doesn't mean that they did not act as medical professionals.

I am not a CAP commander and most decidedly do not make policy, but having a medical section staffed by licensed professionals that puts hands on patients for anything other than a true emergency endangers the corporation.

Period.

As a practical matter, most TACS can tell if a problem is something that can be dealt with with moleskin and band aids, or if we need to call 9-1-1.  For all the stuff in the middle ("twisted ankles", abdominal pain, high fevers, etc. should be seen by some sort of (non-CAP) professional.  These days, the most accessible folks like that are typically the urgent care clinics (aka Doc in the Box).  It's not that big a deal to have the TAC talk with Mom, and then get the kid transported to the clinic where they are usually seen in less than an hour.  The kid's insurance pays (Mom gives a credit card over the phone for any co-pays), and everybody's happy.

The biggest drag is the loss of an adult who escorts the troop to the clinic and waits around.

That's what I use chaplains for.   

[Eclipse]

To tie this back to your hypos, if a TAC could do it, then a TAC should do it.  If it sounds like the TAC couldn't handle it, so we bumped it up to the medical professionals, then that's probably what happened and the dreaded "routine medical care" probably occurred, even if all that happened was that the medic washed it and put on moleskin.

Part of being a medical professional is the skill in diagnosis that tells you when NOT to do something, so the fact that they chose not to do something doesn't mean that they did not act as medical professionals.

The above is likely going to be quoted in my next encampment's senior training.

Well put.

[Slim]

Chris,

See that's the thing.

It's an legitimate question:  "If a TAC can do it, why can't a medic do exactly the same thing?"

And the answer is because the TAC is acting as a lay-person, doing the TAC thing, but medical professionals can never act as lay people -- they are licensed professionals that are held to higher standard.

And I agree with you.  I'm not trying to start an argument or even a lively discussion.  Ok, so the standard, layman's practice for a blister is to wash it out, put moleskin and a band aid on it, then drive on.  Guess what?  The standard for an EMT/medic is the same.  These guys aren't doing anything any different than what anyone else would do. 

To purposefully throw a wrench in the gears, what if you had a TAC officer who was also a paramedic?  Does that same, "Reasonable person" rule apply?  Or, do you send the cadet to the next flight over after telling him "Sorry, I can't put a band aid on you because I'm a paramedic.  Go next door and see Lt Jones, he can hook you up."

Think about it.  The whole point of a negligence/malpractice suit is that the doc failed to meet the "standard of care" of folks with her/his license.  While a lay person is simply held to the standard of an ordinary guy on the street.  If a doc could avoid liability by saying "hey, I wasn't acting as a doc when I sutured that wound, I was acting as a layperson and successful Home Ec grad," then there wouldn't be much left of the whole malpractice thing.

Again, I'm not questioning that.  What I'm questioning is that-under Michigan Compiled Laws-I'm like a police officer.  I'm an EMT regardless of whether my employer is paying me or not.  I have a duty to act all the time.  As long as the accepted standard of care is followed, I'm safe.  We're not giving physicals, stitching wounds, or prescribing medications.  We're doing what is acceptable to a reasonable person to minimize pain and suffering until definitive treatment can be obtained.

So the law holds medical professionals to the standard of medical professionals, even when doing stuff that a layperson could do.

Even when that standard is the same?  Regardless of whether I'm a TAC who took basic first aid 15 years ago, or someone who works in the field every day?  ARC teaches us that the proper thing to do if you suspect a fractured limb is to splint it as it lies and activate 911, or take the person to ER.  EMT school taught me that the thing to do if I suspect a fracured limb is to splint it as it lies and take the person to ER.

To tie this back to your hypos, if a TAC could do it, then a TAC should do it.  If it sounds like the TAC couldn't handle it, so we bumped it up to the medical professionals, then that's probably what happened and the dreaded "routine medical care" probably occurred, even if all that happend was that the medic washed it and put on moleskin.

Again, I think where we're faltering here is what defines routine medical care.  Does putting a band aid on a blister constitute routine medical care, or is it basic first aid?  To me, if it's routine medical care, it shouldn't be done by anyone in CAP; whether that person has an ARC Responding to Emergency card, or is the top neurosurgeon in the country.  Routine is routine. 

Part of being a medical professional is the skill in diagnosis that tells you when NOT to do something, so the fact that they chose not to do something doesn't mean that they did not act as medical professionals.

Unfortunately, not acting when people know I'm an EMT is an option that state laws take away from me.  And someone who sees me pass an accident scene need only look at my back window to know that I'm an EMT (and they have to look really close to see it).  Getting that and my plate number, turning them over to law enforcement, and I'm potentially in a world of hurt.  If I'm in uniform driving home, I have to stop unless someone else is already on scene.  I live in a small town now, where people know me by face, and not just a uniform that stops at the gas station on my way to work.  They recognize me and know what I do for a living.  If I'm in there out of uniform, see someone fall, and do nothing, and the regular clerk looks at me and says "You're an EMT, aren't you going to help him?" and I don't, I could be found negligent in a civil and/or criminal sense.

On the other hand, is someone with or without basic first aid training any less negligent if they take it upon themselves to try and manipulate what they suspect is a sprain, and cause a closed fracture to become open?

I am not a CAP commander and most decidedly do not make policy, but having a medical section staffed by licensed professionals that puts hands on patients for anything other than a true emergency endangers the corporation.

Period.

Any less liability than having such resources available and not properly utilizing them?

As a practical matter, most TACS can tell if a problem is something that can be dealt with with moleskin and band aids, or if we need to call 9-1-1.

Maybe where you are.  Here not so much.  It's not necessarily a training issue as a common sense issue.  EMS was it's own worst enemy when it came to "Dial 911" campaigns.  That's the first thing anyone thinks when confronted with a medical problem.  Johnny fell off his bike and bumped his chin...call 911.  Susie's got a sniffle....call 911.  Jimmy's got a tummy ache....call 911.  Mary stubbed her toe...call 911.  What I see in my daily experience is that people think 911 is going to work miracles (thank you William Shatner).  People think we're lazy when we tell them Susie can go see her doctor in the morning, or we just put a bandaid on Johnny's scraped chin, that they don't need to go to ER.  We're not lazy, we're just trying to keep resources available for the person who really needs us.

For all the stuff in the middle ("twisted ankles", abdominal pain, high fevers, etc. should be seen by some sort of (non-CAP) professional.  These days, the most accessible folks like that are typically the urgent care clinics (aka Doc in the Box).  It's not that big a deal to have the TAC talk with Mom, and then get the kid transported to the clinic where they are usually seen in less than an hour.  The kid's insurance pays (Mom gives a credit card over the phone for any co-pays), and everybody's happy.

And that's what we do, except that that twisted ankle goes with a SAM or pillow splint and an ice pack.  Nothing we can do for anyone else except take them downtown.  The only difference is that we have to use a hospital ER because there aren't any urgent care centers in town.  What would you do if you called a parent and said "Sally's got abdominal pain, we're going to take her to the ER to be seen," and the parent says "Don't you dare!  She's just homesick, she did the same thing at camp last summer."  Then what?  It happened to us a couple of years back, and the commander looked at me and said "You're an EMT, what should I do?"  Who pays if insurance doesn't, or the parents don't have it, or they won't cough up for co-pays?

The biggest drag is the loss of an adult who escorts the troop to the clinic and waits around.

That's what I use chaplains for.   

Couldn't agree with you more there.   

[Eclipse]

Unfortunately, not acting when people know I'm an EMT is an option that state laws take away from me.  And someone who sees me pass an accident scene need only look at my back window to know that I'm an EMT (and they have to look really close to see it).  Getting that and my plate number, turning them over to law enforcement, and I'm potentially in a world of hurt.  If I'm in uniform driving home, I have to stop unless someone else is already on scene.

If that's the case, you're not in CAP when you are responding, regardless of what uniform you are actually wearing. Your state's "duty of care" trumps CAP's regs, but you can't expect them to provide you insurance.

This exact conversation has been going on for years, and will continue until something changes at NHQ.   If you search this board and cadet stuff you will find LOTS of threads about this, or related topics in the ES forums with providing care to victims - same exact issues, with the small extra wrinkle of being in more remote areas where EMS isn't "right there".  Thus we now have a "first responder school" at NESA despite the fact that the statistical reality of CAP being the first on scene in a crash where EMS is not also in the area, approaches zero.

If you hop over to the CAP Health Services Yahoo Group and start this discussion we'll never hear from you again,  because frankly there is no answer, and many members argue that the ambiguity is left in place by design to allow trained professionals to act, while still absolving CAP of official sanction of the actions.

That leaves the member(s) stuck in the middle.

Look anywhere else in the organization and you will find little to no gray area.

Want to fly - no problem.  What you can and cannot do in, with, or near an airframe is spelled out in excruciating detail.

You can't pick up a CAP radio without at least 4 hours of in-house training.

But start talking about HSO issues, and the detail fades away.  Heck, there isn't even a specified standard of training for very basic first aid we >do< need and are discouraged to use.

Many people argue that floating around in a $300,000 Volkswagen with wings is as, or more, dangerous
that having CAP HSO's provide routine emergency care.  After all, we're allowing outside agencies and organizations (i.e. FAA & flight schools) to certify that someone is capable of operating the controls of an airplane in a safe manner. So why can't we allow EMT's, and Dr's, also certified by outside agencies, to use their skills?

The trouble with this analogy is that anything short of an actual crash is generally handled as an administrative issue internally.  There's very little chance of being sued because you "almost crashed", or didn't fly.

[Major Lord]

I don't believe that there is any regulatory authority that states or infers that a
layman can provide even parental levels of first aid "boo-boo" care. The regulations ban both professionals and laymen from rendering any routine medical care, and only permit medical aid of any kind in life-threatening emergencies. Scope of practice or level of training is not relevant unless exceeded.

There are no exemptions for TAC officers to render ordinary first aid, hand over a band-aid, moleskin, etc. or even instruct a member to lie down if they feel faint. Many of you apparently believe that there is some basis for providing non-emergent care, based on our standard practices and common sense. Clearly our regulations were meant to replace common sense. ( this from the people who spent out money on NASCAR, sweet mother of Buddha!)

The regulations are in conflict with morality, best corporate practices,  our duty of care to our cadets and their parents, and possibly law. So I ask you, which should we change?

Change the regulations to allow encampment staff  (preferably, but not necessarily medical professionals) to permit parental- level first aid and medical care!  Band-aids for boo-boos, antaseptic, Other-The Counter medications ( We could make a list of acceptable ones and have parents check of any they would decline) This would allow us to drain and dress blisters, apply band-aids, ice-packs, possibly even hand over a couple of Tylenol or Benadryl if required. In other words, take care of the cadet and keep the activity going, instead of calling parents for every complaint or going to the ER for every alleged injury. A real life medical professional should be present at an encampment, but only for rendering true emergency care, and triaging the endless stream of cadets who suddenly developed asthma, migraines, scurvy, or some other nasty and imaginary disease immediately upon having a three foot high " Sergeant Major" of the encampment do his level best to politely motivate them to run or do pushups.... Ideally, Emergency room nurses or doctors should be used for triage. Many other practitioners will buy into a Cadets' complaints way too much, and don't want to tell Cadets that pain in their legs and shortness of breath are normal when running....And having a Cadet in that position? Are you out of your minds?!!! (they may look sweet, but they would kill us and everyone we love given half a chance!)

Major Lord

[Slim]

If that's the case, you're not in CAP when you are responding, regardless of what uniform you are actually wearing. Your state's "duty of care" trumps CAP's regs, but you can't expect them to provide you insurance.

Oh, I have no such expectation.  My employer provides me with liability and malpractice insurance.  As long as I act within the accepted standard of care, and within my training, with the equipment I have available, I'm covered.

This exact conversation has been going on for years, and will continue until something changes at NHQ.   If you search this board and cadet stuff you will find LOTS of threads about this, or related topics in the ES forums with providing care to victims - same exact issues, with the small extra wrinkle of being in more remote areas where EMS isn't "right there".  Thus we now have a "first responder school" at NESA despite the fact that the statistical reality of CAP being the first on scene in a crash where EMS is not also in the area, approaches zero.

If you hop over to the CAP Health Services Yahoo Group and start this discussion we'll never hear from you again,  because frankly there is no answer, and many members argue that the ambiguity is left in place by design to allow trained professionals to act, while still absolving CAP of official sanction of the actions.

That leaves the member(s) stuck in the middle.

Look anywhere else in the organization and you will find little to no gray area.

Want to fly - no problem.  What you can and cannot do in, with, or near an airframe is spelled out in excruciating detail.

You can't pick up a CAP radio without at least 4 hours of in-house training.

But start talking about HSO issues, and the detail fades away.  Heck, there isn't even a specified standard of training for very basic first aid we >do< need and are discouraged to use.

Many people argue that floating around in a $300,000 Volkswagen with wings is as, or more, dangerous
that having CAP HSO's provide routine emergency care.  After all, we're allowing outside agencies and organizations (i.e. FAA & flight schools) to certify that someone is capable of operating the controls of an airplane in a safe manner. So why can't we allow EMT's, and Dr's, also certified by outside agencies, to use their skills?

The trouble with this analogy is that anything short of an actual crash is generally handled as an administrative issue internally.  There's very little chance of being sued because you "almost crashed", or didn't fly.

Oh, I know.  Ned and I have had this discussion once before over on cadetstuff.  While I see and agree with his position, I don't see it in the same way.  I've tried to make the point that we don't use our medical staff do do anything beyond basic first aid and emergency, life-saving procedures.  Which, in my interpretation of CAPR 160-1, section B, paragraph 6, subsection a, is an acceptable practice.  Subsection b is also religiously complied with.

A lot of laypeople are applying a standard of care to us without knowing what that standard is.  A neurosurgeon couldn't do emergency surgery with a pocket knife, a hacksaw, and a pair of pliers, but they can slap a band aid on a cut, or some 4x4s on a cut head.  A lot of the basic care EMS provides is nothing more than standard first aid stuff.  The more advanced procedures (medications, IVs, etc) are always done via doctor's orders or standing protocols.

[Ned]

Almost too much to respond to here.  I'm sure I'm going to miss a few points.

First, Alan, I think you have created a false dilemma here.  I can only agree that there is no special provision in the regs or other guidance that would allow TAC officers to perform routine first aid or medical care that other members could not perform.

But that is not very surprising because the kind of "boo-boo" care you described so well is neither First Aid nor medical care.

For the purpose of this discussion, let's go ahead and call it Boo Boo Care.

First, we know that putting on a band aid or moleskin is not First Aid because first aid is defined variously as

• "Emergency treatment administered to an injured or sick person before professional medical care is available," or
  
  
• First aid, immediate emergency treatment given to an injured or ill person", or
  
  
• "First aid is emergency care given immediately to an injured person."

(Those are the first three definitions I get when I googled "first aid definition.")



The two common factors here are that first aid is "emergency care," and that it is preliminary to professional treatment.

I don't think anyone in the world would classify a blister, minor cut, or someone who looks faint (your examples) as an "emergency."

Hence, caring for those condictions is NOT first aid -- it's Boo Boo Care.

And caring for these conditions is not "medical treatment" either.  Common sense tells us that medical treatment is treatment by medical professionals.  To hold otherwise makes the whole phrase meaningless.

Mom doesn't perform "medical treatment" by moleskinning a blister.

(BTW, Mom doesn't do "medical treatment" if she were to perform surgery on Junior, either.  She simply commits a crime.)


I'm sure there are definitions of "first aid" floating out there that don't include the "emergency" part, but take a look at how the 160-1 discusses it:

Medical care within CAP is limited to emergency care, only (i.e. first aid and stabilization) within the training and qualifications of the person redering such care, until such time that private professional or authorized military care can be obtained.

This reinforces the second element -- that "first aid" is something given in emergencies where it is anticipated that professional medical care is required.

(That's why it is not "Last Aid."  )

Nobody seriously expects the moleskinned cadet to be seen by a medical professional, hence the act of applying moleskin is NOT first aid.  It is Boo Boo care.



And Chris, I hear the conflict you are describing about your duties under state law as an EMT and CAP's requirement that you not perform routine care.

First, I suspect that Michigan law only requires you to act in emergencies.  IOW, I don't think many EMTs have been prosecuted for walking by a kid with a blister  without stopping and rendering professional care. 

ANd of course in bona fide emergencies, CAP members are permitted to render first aid within their skills and training.

Doesn't sound like a conflict to me.

But even if the Michigan law requires you to take action in non-emergencies, all that does is put the election in your hands.

You may remember the big controversy when CAP said we could not carry concealed (or other) weapons while on duty.  All the various cops and similar officials screamed that they were "required" to carry while off duty since they are cops 24/7 etc.  When checked, it turned out that less than 1% of the cops in the country work for "mandatory carry" departments.  It really did not turn out to be as large a problem as it first appeared.  And ultimately if your civilian responsiblities prevent you from performing your CAP duties, then you may well have some choices to make.  Going to jail for following some CAP regulation is a little much to ask of anyone.

I'm sure I've missed a few points here.  Sorry.

Ned Lee
Former CAP Legal Officer
Former Police Officer
Former EMT

[Ned]

Now that I'm home I can see I did miss a few important points.

I am not a CAP commander and most decidedly do not make policy, but having a medical section staffed by licensed professionals that puts hands on patients for anything other than a true emergency endangers the corporation.

Period.

Any less liability than having such resources available and not properly utilizing them?

YES.

Our official position is that we don't provide routine medical care.  Period. 

We are never going to get sued for failure to provide routine care -- especially when we said we weren't gonna in the first place.  Even if we had a doctor and a clinic hiding in the closet and we could have provided some routine care.

(Remember, we can provide first aid in true emergencies. But even if all we do is call 9-1-1 and await EMS we will be fine.)

What would you do if you called a parent and said "Sally's got abdominal pain, we're going to take her to the ER to be seen," and the parent says "Don't you dare!  She's just homesick, she did the same thing at camp last summer."  Then what? 

I'd do what any ordinary prudent person would do. I would tell Mom that based on the abdominal pain complaint and the fact that Mom isn't here, we are going to take her kid to the ER unless Mom can show up here and sign the kid out to do her own thing.

It happened to us a couple of years back, and the commander looked at me and said "You're an EMT, what should I do?" 

Let me gently suggest that an EMT should not be part of this decision tree for the reasons we have described at some length.  The only helpful input you might have would have something to do with the "life-threateningness" of Sally's complaint of abdominal pain.  A lay person knows that significant abdominal pain is sometimes very serious and could signify Very Bad Things, and sometimes may turn out to be nothing more than an over-ripe MRE.  And lay folks know that lay people do not have the skills and abilities to know the difference.  That's why we take them to the doc.

An EMT could of course do a complete secondary survey, check for things like fever and rebound tenderness, and actually understand the significance of the presence or absence of such things.

Accordingly, any input you give is almost certainly medical care.  Most likely of the routine type (unless we can somehow make this tummyache an emergency situation.)  And if you are wrong, Very Bad Things could happen to the corporation.

This is a decision that should be made by responsible adult - a TAC or a member of the CoC.

Who pays if insurance doesn't, or the parents don't have it, or they won't cough up for co-pays?

Good question.

And the answer is Mom and Dad are on the hook for all of Junior's medical costs.

Period.

Even if they say that they won't pay.  It's a matter between the hospital and the family.  And as you know, they are quite used to dealing with it.  Lots of people don't want to pay their medical bills, and ERs have to provide the care regardless.

But if you want to be nice and pay for it, by all means do so.  I know I have done exactly that myself when uninsured cadets show up at encampment and Mom and/or Dad live 400 miles away and can't/won't come and/or help.

But you don't have to.  And neither is CAP, Inc liable.

[Jolt]

Is routine medical care the same as a routine medical assessment?

[Slim]

Ned,

Are we in agreement that boo-boo care is NEITHER routine medical care or emergency first aid?  Would you be willing to go so far as to stipulate that it doesn't matter who provides said "boo-boo care"?

Are we in agreement that properly immobilizing a suspected fracture constitutes emergency medical care/first aid ("Stabilization" as stipulated in the 160-1)?

Are we further in agreement that one of the duties of an HSO is to advise the commander on issues pertaining to the health and welfare of his/her members (as paraphrased from CAPR 160-1, Sec C Para 7)? 

7. CAP health service personnel are responsible for advising CAP commanders and unit personnel on the health, fitness, disease and injury prevention, and environmental protection of CAP members relevant to CAP activities, with special emphasis on those members involved in flying, emergency services and disaster relief activities, field exercises, encampments, and special activities.

In fact, as I read this section, I'm finding myself developing the opinion that HSOs should be present (in fact, required) at large activities like encampments.  Also note subsection h of section C, para 7:

h. Assist in providing necessary health service training materials, supplies, and equipment for unit missions or special activities, including first aid and blood-borne pathogen/disease prevention kits.

So, an HSO (and EMTs/medics do qualify for this duty according to the reg) has the duty to assist in providing first aid supplies, but can't be allowed to use them?

In the instance cited where my opinion as a medical professional was sought, I advised the commander that we already had consent to treatment by way of the CAPF 31, and took the cadet downtown.  A lay person would be more inclined to write off a tummy ache as no big deal.  As a trained professional, I know all of the things a tummy ache could be, and know that the only way to know for sure is to have the patient taken to an ER for evaluation and treatment (to include x-rays, ultrasounds, bloodwork, etc.) by a doctor.  That's why my opinion was sought, and I advised the commander appropriately, within the scope of my qualifications and experience.

Again, where I think we're in disagreement is in what constitutes an emergency, and emergency first aid/treatment.  A freely bleeding scalp laceration (keeping in mind that the thinnest skin on the body is on the head, and head wounds tend to bleed a lot)?  An ankle that could be broken, and needs to be immobilized/stabilized before moving the patient?  Assisting a cadet with administering an EPi pen after a bee sting when signs of allergic reaction are present?  Dressing a laceration on the arm to control bleeding while waiting for EMS, or during transport to the ER.

I'll stipulate that these aren't too routine, even for a physically challenging activity like encampment.  However, if an encampment is so physically demanding that injuries like these become routine, you need to take a long, hard look at your ORM matrix and safety protocols.

I can dress a blister just as well as the next guy; that isn't the contention now that you've stated your opinion that this isn't medical treatment at all ("Boo-boo care").  My concern comes from the situations I've described, where I may be held liable for my inaction professionally, or for my actions by CAP.  Do I do what i know is morally right as a human and medical professional, or do I do what is deemed right by regulations? 

"Above all else...Do no harm"--The first rule of medicine.

In the end, I'm sure we're going to have to agree to disagree here.  I see the medical program used at my encampment as being well within the purpose and intent of the CAPR 160-1.  I have no issue with the way we do things here, and neither does my chain of command, else we wouldn't be doing it.  Your mileage certainly varies.  Perhaps another hang-up is the terminology I'm using.  Would it make more sense if I called it a health service program?

Either way, it's been a productive, educated discussion.  Thanks 

[Ned]

Ned,

Are we in agreement that boo-boo care is NEITHER routine medical care or emergency first aid? 

Yes, when performed by non-HSOs, like TACs or other CP senior members.

Would you be willing to go so far as to stipulate that it doesn't matter who provides said "boo-boo care"?

(Oooh.  "Stipulate."  This from the same guy who coined "Boo-Boo Care."  )



No.  In my view, HSOs should not administer Boo Boo care because care performed by medical professionals is most circumstances will amount to the dreaded (and prohibited) "routine medical care," essentially by definition.

  And, yes, I understand that this means that trained profesionals can cannot do some "medical things" (really Boo-Boo care) that TACs and others may routinely do.  While that seems like a paradox, it is simply is a way to prevent the exception from eating the rule (or the camel's nose under the tent or what ever your favorite metaphor that describes a slippery slope problem might be.)

If we stick to a model that says TACs and others can provide the same kind of care that Mom or Dad could (in loco parentis), and while simultaneously prohibiting HSOs from performing routine medical care, the corporation is not endangered.  And remember, in a true emergency, anyone can perform first aid within their skills and abilities.

Are we in agreement that properly immobilizing a suspected fracture constitutes emergency medical care/first aid ("Stabilization" as stipulated in the 160-1)?

Yes, assuming a reasonable person would suspect a fracture that would benefit from imobilization and the victim is to be subsequently seen by a doc.

Are we further in agreement that one of the duties of an HSO is to advise the commander on issues pertaining to the health and welfare of his/her members (as paraphrased from CAPR 160-1, Sec C Para 7)? 

Of course.  HSOs are important in advising commanders about such things in general, and even about specific concerns about a given member based on something like a review of the medical portion of the activity application.

Example:"Hey boss, after going over the apps, it looks like there will be three kids attending with ADD/ADHD; we should probably alert the chaplain and their TACs to watchful for signs of stress or behavioral issues.  Also, there are two troops bringing their asthma inhalers.  Make sure that these are not collected and held by the staff, since the kid might need it at any time."

But this should not be stretched to providing routine care and diagnosis dressed up as advice.

Example:  "Hey boss, my job is to give you health advice about our members at encampment. I have performed an examination of Cadet Jones and my 'advice' after looking at the x-rays is to take this kid to the ER."

See the difference?

In fact, as I read this section, I'm finding myself developing the opinion that HSOs should be present (in fact, required) at large activities like encampments. 

While I would support the general notion of having HSOs at all activities, I think it would be a very serious error to require it.

First, as a practical matter we simply don't have enough qualified HSOs of the right type (debateable, but probably LVN or better,) to give us 10 days each summer for an encampment.  If we required such a thing, we would likely simply wind up having to cancel a significant percentage of the encampments without adding much in the way of value to the activities that do have an HSO in attendance.

We have been doing encampments for over 50 years in almost every wing, and the great majority of them have been done safely without an HSO. 

Second, as I touched on above, our "HSO tent" is a very large one, and covers virtually the whole range of the allied health professions including not only docs, nurses, PAs, paramedics, and EMTs, but also dietitians, psych techs, and even optical technicians.

I'm not sure having an optical technician at encampment would be very helpful. 

Also note subsection h of section C, para 7:

h. Assist in providing necessary health service training materials, supplies, and equipment for unit missions or special activities, including first aid and blood-borne pathogen/disease prevention kits.

So, an HSO (and EMTs/medics do qualify for this duty according to the reg) has the duty to assist in providing first aid supplies, but can't be allowed to use them?

Of course HSOs (along with anyone else) can use first aid kits for giving first aid in a genuine emergency.  But they cannot use the contents of the first aid kit for providing non-emergency care (routine care) or even Boo-Boo care.

In the instance cited where my opinion as a medical professional was sought, I advised the commander that we already had consent to treatment by way of the CAPF 31, and took the cadet downtown.  A lay person would be more inclined to write off a tummy ache as no big deal.  As a trained professional, I know all of the things a tummy ache could be, and know that the only way to know for sure is to have the patient taken to an ER for evaluation and treatment (to include x-rays, ultrasounds, bloodwork, etc.) by a doctor.  That's why my opinion was sought, and I advised the commander appropriately, within the scope of my qualifications and experience.

I don't want to get into commenting on the specifics of what y'all did or didn't do, but I would suggest that what you have described supports a conclusion that the commander was relying on professional medical advice in making her/his decision.  And that's extremely dangerous whevever it is not a true emergency situation.

Again, where I think we're in disagreement is in what constitutes an emergency, and emergency first aid/treatment. 

Then let's clear that up.  Here's the screen I get when I Google "define medical emergency.".

• means an Accidental Injury or a condition that occurs suddenly and unexpectedly and is life threatening or could result in permanent damage if not treated immediately. ...
  
  
•   A medical condition manifesting itself by "acute symptoms of sufficient severity-including severe pain-such that a prudent layperson could reasonably expect the absence of medical attention to result in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any ...
  
  
•   A medical emergency is an injury or illness that poses an immediate threat to a person's health or life which requires help from a doctor or hospital.
  
  
•   'Emergency Medical Condition' means a medical condition manifesting itself by acute
  symptoms of severity (including severe pain) such that a prudent lay person, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
  (a) placing the health of the individual in serious jeopardy;
  (b) serious impairment of bodily functions; or
  (c) serious dysfunction of any bodily organ or part.
  
  

I'm sure there are more out there.  There are probably some good ones in the Michigan Compiled Statutes and perhaps one of your EMT text books.

So with these definitions in mind, let's take a look at your examples:

A freely bleeding scalp laceration (keeping in mind that the thinnest skin on the body is on the head, and head wounds tend to bleed a lot)? 

Well, I suspect if the lac is gaping or would benefit from sutures, then it is probably the kind of thing they were talking about when they talked about "requiring help from a doctor or hospital," or could result in "permanent damage," so yup in my lay opinion, this could qualify as emergency and accordingly and CAP member (inlcuding HSOs) could render first aid.

An ankle that could be broken, and needs to be immobilized/stabilized before moving the patient? 

Pretty much the same answer, the suspected fx needs to be seen by a doc and failure to set a fx could result in permanent impairment of a body part.

My concern comes from the situations I've described, where I may be held liable for my inaction professionally, or for my actions by CAP.  Do I do what i know is morally right as a human and medical professional, or do I do what is deemed right by regulations? 

Again, I don't see the conflict here.  Assuming that Michigan only requires you to take action in emergencies, then there is no conflict at all with the CAP administrivia.

(If you can point me to the applicable MI law, I'd be happy to take a look at it.)

In the end, I'm sure we're going to have to agree to disagree here. 


Either way, it's been a productive, educated discussion.  Thanks 

Back at ya.

[sarmed1]

One of the options discussed in another thread........
I had a talk with the former National Commander at HMRS this past year.

He was very impressed with the core of thier medical support program.
...an Active Duty Doctor, offers his services free of charge with his own insurance for the duration of the activity.  (I wont get into the the other "issues" people have with their "medic" program)

His proposal was to develop a more comprehensive "medical unit" type program within CAP...ie Wing or Reginal "medical squadrons" wherer all of the HSO types are assigned.  When a large event occurs within that units area of responsability, CAP purchases (or activates) an insurance policy to cover the needed medical personnel for the duration of that specific activity. Cheaper and easier to manage than the idea of 100% coverage all day every day even if there is no CAP activity going on.

We also discussed the option of a program similar to the Chaplin program for the AF, where CAP HSO's meet the same "train and maintain" requirements as the AF counterparts, and are then "called to service" by the AF to provide support to its auxillary for events such as encampments, NCSA or even SAR/DR missions....

option 1 was agreed to be the easier (and quicker) of the two to accomplish.

He had asked me to develop a brief/proposal for him and legal to review for presentation...not sure where that would go with the regieme change (the current NC was in on this brief)

mk

[Ned]

Either may well work.

The former is similar to a solution I have used.

One year I "hired" an RN to work as a "encampment nurse."  She was not a CAP member.  She then went to the local urgent care center and coordinated some protocols from their MD medical director (presumeably in exchange for an agreement to send cases their way if parents and insurance would permit).

I then bought a commercial "camp nurse" liability policy through a broker that covered both the RN and CAP, Inc.  IIRC, it was about $10/head for the 10 day encampment period.

I coordinated all this through the corporate legal folks at NHQ and it worked fine.

The upside was that I had an RN on site to do the triage that we all need at encampment (which knee injury needs an x-ray, which should just be iced, etc) and happily it turned out that she was a terrific person who strongly encouraged cadets with minor health complaints to remain engaged in encampment.

The downside was the $2,500 or so for the policy.  Without question that is money that can be spent elsewhere at encampment if other arrangements can be made for medical care.


I only had to do this one time.  Since then we have been able to finagle sufficient mandays to hire a ANG nurse or medic to help us out.  This is kinda like your AD doc in the sense that it doesn't cost anything and as USAF folks, the liability situation is much improved.

Thanks for sharing possible solutions.

Ned Lee
CP Enthusiast
Former Legal Officer

[Eclipse]

An interesting solution, but a far-cry from the EMT cadet running around with a stethoscope.

And as you say, the cost is hard to justify when 9-1-1 is "free".

[PA Guy]

And as you say, the cost is hard to justify when 9-1-1 is "free".

Calling 9-1-1 for the minor problems treated and or triaged by the RN would, I think, wear out your welcome really fast with the EMS community.

[Jolt]

And as you say, the cost is hard to justify when 9-1-1 is "free".

Calling 9-1-1 for the minor problems treated and or triaged by the RN would, I think, wear out your welcome really fast with the EMS community.

Not to mention the response time would get longer and longer with each call.

[Eclipse]

And as you say, the cost is hard to justify when 9-1-1 is "free".

Calling 9-1-1 for the minor problems treated and or triaged by the RN would, I think, wear out your welcome really fast with the EMS community.

Not to mention the response time would get longer and longer with each call.

If you guys are running activities where the amount of EMS response needed is so high they are
getting annoyed with you, you need to look at the activity or the participants, not CAP medical regulations.

911 is for life and death emergencies, twisted ankles go to the ER.  In either case, a CAP "medic" is not needed.

[SAR-EMT1]

Just want to mention that to dial 911 is free, but anything that responds is going to cost you, depending on the state and county codes.

Locally... (Central Illinois)
a 911 call resulting in a police car responding will cost $100- billed to the criminal if caught or the caller (if no felony crime was involved)

911 resulting in fire dept response: varies from $200 to $500 within my county.

911 resulting in EMS response:  $200 to $500

These are charges racked up, simply for the unit responding. Refusals are still billed Any medical supplies used to treat a wound, expended mace canisters, or time and supplies spent fighting a fire are all extra.

Senario: cadet has stomach pain, mom called, says its homesickness, dont take her. ... Encampment staff decide to call 911 and have her checked anyway.  ... Well the folks making the call whether CAP Inc, ABC Wing, or the Encampment Commander would get a Bill ranging from 200 to 500 dollars.
NOT Mom. All mom would have to say on the phone to the Ambulance EMT is: I did not authorize the response.  Then CAP or Joe Senior Member pays.


Granted 911 isnt necessarily for a tummyache or blister. But I couldnt let the "911 is free" comment pass.

[PHall]

Just want to mention that to dial 911 is free, but anything that responds is going to cost you, depending on the state and county codes.

Locally... (Central Illinois)
a 911 call resulting in a police car responding will cost $100- billed to the criminal if caught or the caller (if no felony crime was involved)

911 resulting in fire dept response: varies from $200 to $500 within my county.

911 resulting in EMS response:  $200 to $500

These are charges racked up, simply for the unit responding. Refusals are still billed Any medical supplies used to treat a wound, expended mace canisters, or time and supplies spent fighting a fire are all extra.

Senario: cadet has stomach pain, mom called, says its homesickness, dont take her. ... Encampment staff decide to call 911 and have her checked anyway.  ... Well the folks making the call whether CAP Inc, ABC Wing, or the Encampment Commander would get a Bill ranging from 200 to 500 dollars.
NOT Mom. All mom would have to say on the phone to the Ambulance EMT is: I did not authorize the response.  Then CAP or Joe Senior Member pays.


Granted 911 isnt necessarily for a tummyache or blister. But I couldnt let the "911 is free" comment pass.

That's in Illinois, it's different in California just as it's different in New Jersey.

For example:
In California if you call 911 about the only thing you are billed for is the Ambulance and the ER.
The Cops and the Fire Department are tax payer supported.

About the only things most PD's in California bill for is false alarms from your burglar alarm.
And usually the first one is free.

[isuhawkeye]

Im sure this will really tweek some of you here, but enjoy.

[Eclipse]

Just want to mention that to dial 911 is free, but anything that responds is going to cost you, depending on the state and county codes.

Locally... (Central Illinois)
a 911 call resulting in a police car responding will cost $100- billed to the criminal if caught or the caller (if no felony crime was involved)

911 resulting in fire dept response: varies from $200 to $500 within my county.

911 resulting in EMS response:  $200 to $500

These are charges racked up, simply for the unit responding. Refusals are still billed Any medical supplies used to treat a wound, expended mace canisters, or time and supplies spent fighting a fire are all extra.

Senario: cadet has stomach pain, mom called, says its homesickness, dont take her. ... Encampment staff decide to call 911 and have her checked anyway.  ... Well the folks making the call whether CAP Inc, ABC Wing, or the Encampment Commander would get a Bill ranging from 200 to 500 dollars.
NOT Mom. All mom would have to say on the phone to the Ambulance EMT is: I did not authorize the response.  Then CAP or Joe Senior Member pays.

Your experience with billing and EMS costs are not typical of the rest of the world, or even in Illinois - some back charge, some don't.

Obviously any ES response is not "free", however CAP as an entity is not liable for Ambulance or EMS charges incurred for its members - that is the responsibility of the members and covered by their health insurance.

A senior member who is lucid and coherent would take personal responsibility for their transport - if they want 911, great, if not, and decide to self transport, their call.  Adults have that right.

A senior member who is unconscious cannot make the call, and there should be no question.

A cadet,  in either circumstance, by the nature of their standing within CAP, does not have that right, regardless of their age.  At least within CAP, they are still considered "minors" in a lot of cases, and are subject to the discretion of their senior-member commanders, who, if they choose, can send them for medical care, via self-transport or 911, at the expense of their parents', or own, health insurance.

I will grant that external to CAP, most states recognize 18 as the legal age of adulthood, and in those cases we have less latitude to  bar a cadet from making their own decisions >legally<, however they would be subject to internal disciplinary action, including the possibility of termination, if they disobeyed the directives of their commanders.

Depending on their situation or attitude, they may not care, but that doesn't change things.

And please leave the larger issue of people without health insurance out of this.  Its not part of the discussion.

[isuhawkeye]

Sorry I think the document had a problem. Here it is again

[PHall]

Sorry I think the document had a problem. Here it is again

Still has a problem.

[jimmydeanno]

Just want to mention that to dial 911 is free, but anything that responds is going to cost you, depending on the state and county codes.

Yep around here the only thing that costs is if the call is fraudulent (prank call) or medical transport not provided by fire department (billed to insurance.)  Since police and fire are tax payer funded they are "obligated" to respond to calls for help "free of charge."

[Michael]

If you have any CAP Ranger Medics around in your wing, that shouldn't hurt. 

[SAR-EMT1]

In terms of medical Control or authority a CAP " Ranger medic"  doesnt cut the mustard.

Though the NESA does have a First Responder class.

[mikeylikey]

If you have any CAP Ranger Medics around in your wing, that shouldn't hurt. 

hahahhahhahha blah hahahahhahhah blah blah hahahahhahaha   

[SJFedor]

If you have any CAP Ranger Medics around in your wing, that shouldn't hurt. 

I second mikey's uncontrollable laughter at that statement.

[mikeylikey]

If you have any CAP Ranger Medics around in your wing, that shouldn't hurt. 

I second mikey's uncontrollable laughter at that statement.

Thank you.  You Sir are a fine Officer! 

[FW]

If you have any CAP Ranger Medics around in your wing, that shouldn't hurt. 

hahahhahhahha blah hahahahhahhah blah blah hahahahhahaha   

Ok guys, you're reacting to the opinion of a cadet.  Be nice, but I'm glad I wasn't drinking anything while reading that remark;  I would have destroyed my computer with the expelled liquid.

[Jolt]

I didn't say anything because I think he's being serious.

[DC]

Having never been to Hawk Mountain, or worked with a Ranger Medic, I don't know what their skill level is. I do know someone who has been to the NESA program, and in my opinion the medical training leaves something to be desired...

[Michael]

Out of all seriousness, I apologize to the entire Ranger Program and Ranger Medic Program for putting such a well trained and good-hearted group of individuals into a bad light.

[FW]

Cadet, there is no reason to apologize for your comments.  The Ranger program as well as it's medic program are fine;  for what they are intended.   It is not a training program for encampment medical staff nor are ranger "medics" trained for anything other than advanced first aid - CPR.  

[sarmed1]

I am of course biased as one of the people that trains Ranger Medics....but I would rather have them around than some of the other "cadet Medics" I see some encampments use.  Usually they come up with a "...you'd' be a good cadet medic because you are an EMT.." kind of theory  Which ends up with a bunch of guys with an ambulance on their backs running around waiting for the big one.
Emergency medical care is only one facet of the curriculum, no where in EMT class did I ever get into anything about injury/illness prevention or areas like monitoring good oral hydration or keeping tabs on basic foot care etc etc.

More importantly somewhere in the TAC officer training plan should be a bigger focus on health and medical issues.....not a blanket clause like "go find a medic"

mk

[Eclipse]

More importantly somewhere in the TAC officer training plan should be a bigger focus on health and medical issues.....not a blanket clause like "go find a medic"

No, there shouldn't.

[sarmed1]

I am not saying that we should cross train Tacs as medics, only that in the absence of an authorized "medical component" to enncampment, the attitude of "...go see the medic..." is not the appropriate one, when Tac's can handle/prevent most problems.  An appropraite advisement capacity for a medical officer is to ensure that Tac Officers have the base understanding of medical conditions of the cadets they are responsible for and the knowlege of basic first aid care for until EMS arrives. 

mk

[DNall]

I'd agree that TACs should have some additional trng in health, safety, & prevention issues. I'd go as far as saying it should be part of the cadet programs officer specialty track, and part of encampment staff trng.

Does anyone really have a problem with that? I'm mean God forbid they might be over-prepared for most situations & able to deal with the serious ones till help arrives (ISRs are great aren't they).